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Background: The treatment of infants with bronchiolitis is largely supportive. The role of bronchodilators is controversial. Most studies of the use of bronchodilators have enrolled small numbers of subjects and have examined only short-term outcomes, such as clinical scores. Methods: We conducted a randomized, double-blind, controlled trial comparing nebulized single-isomer epinephrine with placebo in 194 infants admitted to four hospitals in Queens-land, Australia, with a clinical diagnosis of bronchiolitis. Three 4-ml doses of 1 percent nebulized epinephrine or three 4-ml doses of normal saline were administered at four-hour intervals after hospital admission. Observations were made at admission and just before, 30 minutes after, and 60 minutes after each dose. The primary outcome measures were the length of the hospital stay and the time until the infant was ready for discharge. The secondary outcome measures were the degree of change in the respiratory rate, the heart rate, and the respiratory-effort score and the time that supplemental oxygen was required. Results: There were no significant overall differences between the groups in the length of the hospital stay (P=0.16) or the time until the infant was ready for discharge (P=0.86). Among infants who required supplemental oxygen and intravenous fluids, the time until the infant was ready for discharge was significantly longer in the epinephrine group than in the placebo group (P=0.02). The need for supplemental oxygen at admission had the greatest influence on the score for severity of illness and strongly predicted the length of the hospital stay and the time until the infant was ready for discharge (P<0.001). There were no significant changes in the respiratory rate, blood pressure, or respiratory-effort scores from before each treatment to after each treatment. The heart rate was significantly increased after each treatment with epinephrine (P=0.02 to P<0.001). Conclusions: The use of nebulized epinephrine did not significantly reduce the length of the hospital stay or the time until the infant was ready for discharge among infants admitted to the hospital with bronchiolitis. N Engl J Med 2003;349:27-35. [ABSTRACT FROM AUTHOR]

Background: Previous studies suggest that a high proportion of persons at high risk of cardiovascular disease in Australia are not receiving adequate disease prevention with blood pressure and lipid lowering therapy. However, it is not clear how a move to an absolute risk factor approach will affect the proportion of the population that is treated with blood pressure and lipid lowering therapy versus treatment based on individual risk factors., Methods: We classified participants in the AusDiab follow up cohort study who had no previous history of cardiovascular disease and who were not taking blood pressure or lipid lowering medication currently according to the presence of individual risk factors versus combined absolute risk., Results: Of the 3627 participants who were untreated, 429 (12%) had elevated blood pressure and 983 (27%) had dyslipidaemia, with 167 (5%) having both risk factors. 1245 participants (34%) would be treated using the individual risk factor approaches and 281 (8%) using the absolute risk approach based on the most clearly defined criteria of high risk., Conclusion: Moving to an absolute risk approach prioritises treatment to those most at risk, but ambiguities regarding what is meant by the absolute risk approach remain.